Rescue Bowel Preparation: Same Day 2 L Polyethylene Glycol Addition, Not Superior to Bisacodyl Addition 7 Days Later

Abstract

The two groups did not differ in rescue BP failure rate. Initial BP failure after adequate consumption of 4 L PEG may be a risk factor for rescue BP failure. A stricter BP regimen should be considered for these patients.

Multicentre endoscopist-blinded randomised clinical trial to compare two bowel preparations after a colonoscopy with inadequate cleansing: a study protocol

“…Similarly, 4 L of PEG-ELS can be given over 4 hours to rapidly treat hepatic encephalopathy 32. Lastly, 6 L of PEG-ELS has already been used in a study of 85 patients with failed bowel prep without untoward effects 19. Thus, we expect the use of 6 L split-dose PEG-ELS in regimen B of the study to be safe.…”

“…Fifteen milligrams of bisacodyl was used instead of 10 mg to avoid a dose reduction since low-volume PEG-ELS with bisacodyl is given as 15 mg in Canada (BiPegLyte, Pendopharm, Montreal, Canada). Regimen B was adapted from Kim et al 19 as a more intensive yet tolerable regimen by adding an additional 2 L PEG-ELS to Regimen A.…”

“…An adequacy rate of 70% was selected based on the existing literature 17 19. Additional factors considered in arriving at this figure include the use of low-volume sodium phosphate,17 inadequate use of split dosing17 and poor intake of PEG-ELS,19 all at the index colonoscopy of prior studies. Accordingly, this would indicate that subjects enrolled in the current trial will represent a more difficult to cleanse population, given they would have failed modern-day split-dose bowel preparation despite being compliant to PEG-ELS intake, unlike prior studies.…”

“…Unfortunately, most patients did not receive split-dose bowel preparation at the index colonoscopy, which is now a standard practice due to superior cleansing, and the study did not include a control group 18. In another study, 85 patients with inadequate bowel preparation after split-dose PEG-ELS (4 L) were offered a repeat colonoscopy the same day after ingestion of an additional 2 L of PEG-ELS or a colonoscopy 1 week later using a 7-day low-fibre diet, 20 mg of bisacodyl and 4 L split-dose PEG-ELS 19. There was no difference in adequacy of bowel preparation although the intervention was not randomised, and 20% of cases were still inadequate.…”

Advances in Bowel Preparation for Colonoscopy

“…In another study of patients with an inadequate preparation after 4-L PEG, 20-mg oral bisacodyl combined with 4-L PEG was associated with a salvage rate of 80% on repeat procedure. 42 Even more successful was an intensive regimen that included a low-residue diet for 72 hours followed by liquids for 24 hours, combined with 10 mg of oral bisacodyl plus 1.5 L of PEG with electrolytes the evening before procedure, and another 1.5-L PEG with electrolytes on the day of colonoscopy. Ninety percent of patients had an adequate preparation as assessed using the Boston Bowel Preparation Scale (BBPS).…”